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Disaccharide-Free Diet
What is disaccharide intolerance?
Sugars, starches, and complex carbohydrates in foods are broken down into smaller and smaller sugars by
enzymes until eventually single sugars are absorbed into the body. Disaccharides are two single sugars that are
linked together. Disaccharide intolerance is the inability to break apart the disaccharide into two single sugars and
absorb them. This often leads to uncomfortable digestive-tract symptoms.
What causes it?
There are a variety of conditions that may lead to disaccharide intolerance. Here are three common types
of causes:
• Lack of the enzyme needed to break down the disaccharide. This is an inherited tendency. The most
commonly seen case is lactose intolerance, which occurs when the individual lacks the ability to produce the
enzyme lactase that breaks down the disaccharide sugar lactose found in milk. Another example is a sucraseisomaltase deficiency, which causes sucrose and maltose intolerances.
• Inflammatory damage to the cells of the small intestine. Because disaccharide enzymes are made in the
cells lining the small intestine, this results in disaccharide enzymes not being produced and leads to
disaccharide intolerance. This can result from two different causes.
−
Infections in the digestive tract damage the cells lining the small intestines. Infections can be caused by
parasites, microorganisms (bacteria), and viruses.
−
Inflammation can also be caused by a food allergy. Cow’s milk and soy protein-sensitive allergy or
enteropathy and gluten-sensitive enteropathy (celiac disease) are examples of this cause of disaccharide
intolerance.
• Intestinal damage caused by drugs or medications. Use of strong drugs and medications taken by mouth,
such as antibiotics, may cause damage to the intestinal cells, resulting in a disaccharide intolerance.
What are the symptoms?
Excess sugar in the large intestine leads to more fluid being drawn in to help normalize the osmotic pressure. This
produces gas and an increase of microbial growth and fermentation in the bowel. Symptoms that commonly result
are:
• Abdominal bloating
• Abdominal pain
• Flatulence
• Watery diarrhea or loose stool
• Occasional constipation
Dietitian: __________________________
Phone: ___________________________
Facility: __________________________
• Occasional nausea and vomiting
This handout is meant for use during an appointment with a registered dietitian only, and is not intended for use by other clinicians.
© 2016 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not
be used to treat a health problem or disease. Please consult your healthcare provider if you have questions or concerns. Patient and Provider Publications RD033 – 01/17
1
How long does it last?
• Primary deficiency: If the disaccharide intolerance is an inherited tendency (your body doesn’t make the
disaccharidase enzymes), then the intolerance will be life-long.
• Secondary deficiency: If the intolerance is a result of damage to the intestinal cells caused by infection, food
allergy, or strong drugs, then it is usually temporary. Once the intestinal cells start to heal; you will gradually
resume production of the disaccharidase enzymes.
How can I prevent it?
• Primary deficiency: cannot be prevented because it is an inherited problem.
• Secondary deficiency can be prevented by avoiding: intestinal infections, the use of strong drugs, and
consuming foods that you are allergic to.
How is it treated?
Disaccharide intolerances are treated by removing foods that contain the problem sugar from your diet. In most
cases, disaccharide intolerance is dose-related. Usually the intestinal cells are producing a limited amount of
disaccharidase enzyme, and small doses of foods containing disaccharides can be processed. Problems result
when the amount of disaccharide in the food exceeds the capacity of the enzymes to digest it. The important thing
is to determine your own body’s capacity to handle disaccharide. By remaining within your personal limits, you
should remain symptom-free.
The Problem Disaccharides
LACTOSE
Lactose is the sugar found in milk and is made of glucose + galactose. Lactase is the enzyme needed to break
these sugars apart. Lactose occurs mostly in the whey (liquid) fraction of milk, although foods made mainly of
casein (such as cheeses) may still contain a small amount of lactose. Lactose intolerance is different from a milk
allergy, in which a person’s immune system fights the protein in milk (not the sugars).
SUCROSE
Sucrose is a disaccharide made of glucose + fructose sugars. This sugar is broken down by the disaccharidase
sucrase. Sucrose is found in table sugar and syrups, but is also present in many plants, especially fruits, grains,
and vegetables.
MALTOSE
Two glucose sugars are linked together to form maltose. Maltase and isomaltase are the enzymes that break
down maltose. Maltose is found mostly in grains and starchy vegetables.
STARCHES
Starches are made of long chains of glucose molecules. Enzymes must split all the linkages between the glucose
molecules before the body can be use them. If there is a deficiency in the enzymes, then the remaining
undigested starch or sugar will be passed to the large bowel where bacteria will ferment it, resulting in the
symptoms discussed earlier.
This handout is meant for use during an appointment with a registered dietitian only, and is not intended for use by other clinicians.
© 2016 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not
be used to treat a health problem or disease. Please consult your healthcare provider if you have questions or concerns. Patient and Provider Publications RD033 – 01/17
2
Nutritional Supplements
For people with primary deficiencies, or those who need to follow the diet for an extended period of time, the
following supplements may be necessary:
• Lactose restricted: calcium and possibly vitamin D
• Sucrose restricted: vitamin C
• Maltose restricted: vitamin B complex
The Disaccharide-free Diet
All disaccharides must be restricted initially.
Phase 1 should be followed for a minimum of four weeks to find out if an enzyme deficiency is the cause of the
gastrointestinal symptoms, specifically diarrhea. When the diarrhea improves, loosening of these restrictions will
determine each individual’s tolerance for each disaccharide.
Phase 2 helps determine the individual’s tolerance for each disaccharide. The individual introduces one food from
the “restricted” lists every other day until diarrhea recurs. Lactose tolerance is determined by introducing dairy
products and milk. Sucrose tolerance is determined by introducing vegetables, fruits, nuts and seeds, and finally
sugars. Maltose tolerance is determined by introducing grains, especially “white” grains and flours.
FOOD GROUP
Fats
FOODS RECOMMENDED
• Pure vegetable oil
• Butter
•
• All except those listed to the left
−
Canola
• Margarine with whey or milk solids
Corn
− Flaxseed
− Olive
− Safflower
− Soy
− Sunflower
• Margarine or diet spreads without whey
or milk solids
• Lard, meat drippings
−
Milk and Milk
Products
FOODS TO AVOID
•
Cheeses
− Brie
− Camembert
− Cheddar
− Gruyere
− Limburger
− Monterey Jack
− Mozzarella
− Port du Salut
Non-dairy creamers
This handout is meant for use during an appointment with a registered dietitian only, and is not intended for use by other clinicians.
© 2016 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not
be used to treat a health problem or disease. Please consult your healthcare provider if you have questions or concerns. Patient and Provider Publications RD033 – 01/17
3
FOOD GROUP
Fruits
FOODS RECOMMENDED
Fresh, frozen, canned in own juice:
• Berries: blackberry, blueberry,
cranberry, gooseberry, loganberry
• Cherry
• Currants, red and black
• Damson plums
• Figs, raw
FOODS TO AVOID
• Frozen or canned
fruit with added
sugar or syrup
• Apple
• Apricot
• Banana
• Date
• Grapefruit
• Guava
• Mango
• Grapes, grape juice
• Melon:
• Kiwi fruit
• Lime
• Passion fruit
Grains
Fresh, frozen, canned, without added
sugar or starch:
•
Avocado
•
Chives
•
Endive
•
Green onion
•
Lettuce
•
Parsley
•
Celery
•
Cucumber
•
Garlic
•
Kale
•
Mushroom
•
Parsnip
• None
• Peach
• Pear
• Pineapple, raw
• Plum, prunes
• Raspberry
• Strawberry
• Tangerine
cantaloupe,
honeydew,
watermelon
• Lemon
Vegetables
• Papaya
• Peppers
(green & red)
• Potato:
−
French fried
− Hash browns
• Radish
• Spinach
• Swiss chard
• Tomato
• Tomato juice
• Turnip
• Watercress
Fresh, frozen, canned with additives, added
sauces, or added butter or margarine:
•
Asparagus
•
Broccoli
•
Artichokes
•
Cabbage:
−
Green
− Red
•
Carrot
•
Corn
•
Cauliflower
•
Kohlrabi
• Leeks
• Okra
• Onion
• Potato: boiled
• Pumpkin
• Squash, all types
−
Sweet potato
−
Yam
All, including:
•
Flours made
with grains
•
Barley
•
Bulgur
•
Millet
•
Amaranth
•
Buckwheat
•
Corn
• Oats
• Quinoa
• Rice
• Rye
• Spelt
• Triticale
• Wheat
This handout is meant for use during an appointment with a registered dietitian only, and is not intended for use by other clinicians.
© 2016 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not
be used to treat a health problem or disease. Please consult your healthcare provider if you have questions or concerns. Patient and Provider Publications RD033 – 01/17
4
FOOD GROUP
Meat and Meat
Substitutes
FOODS RECOMMENDED
All fresh or frozen:
Meats that are:
• Lamb
• Processed
• Pork
• Smoked
• Beef
• Breaded
• Wild game
• Poultry: chicken, duck, turkey
•
Legumes
FOODS TO AVOID
Fish, shellfish
• Eggs (plain)
• Cured
• Canned
• Corned beef
• Eggs with added milk, flour, or sugar
• Tofu
All, including:
• Bean sprouts
• Kidney beans
• Broad beans
• Navy beans
• Black-eyed peas
(fava beans)
• Chickpeas
(garbanzo beans)
• Green and
wax beans
Nuts and Seeds
• None
All, including:
• Lentils
• Peanuts
• Peas
• Split peas
• Soybeans
• Almond
• Pecan
• Brazil nut
• Pumpkin seed
• Beechnut
• Cashew
• Hazelnut
Sugars and
Sweeteners
• Glucose
• Dextrose
• Fructose
(fruit sugar)
• Levulose
• Honey
• Sugar substitutes
(if lactose free, in
moderation):
−
Aspartame
−
Cyclamate
−
Saccharine
−
Sugar twin
−
Equal
−
Sweet’N Low
• Macadamia
• Pistachio
• Sesame seed
• Sunflower seed
• Walnut
• Sucrose (table sugar)
• Lactose (milk sugar)
• Maltose (grain sugar)
• Foods with added sugars
• Syrups
This handout is meant for use during an appointment with a registered dietitian only, and is not intended for use by other clinicians.
© 2016 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not
be used to treat a health problem or disease. Please consult your healthcare provider if you have questions or concerns. Patient and Provider Publications RD033 – 01/17
5
FOOD GROUP
Spice and Herbs
FOODS RECOMMENDED
• Allspice
• Mace
• Bay leaf
• Nutmeg
• Anise seed
• Basil
• Caraway
• Cayenne
• Celery
• Chervil
• Chili powder
• Cinnamon
• Cloves
• Coriander
• Dill
• Fennel seed
• Fenugreek
• Garlic powder
• Ginger
• Marjoram
• Mustard
FOODS TO AVOID
• Herb or spice mixes or seasoning
packets
• Curry
• Onion powder
• Oregano
• Paprika
• Parsley
• Pepper
• Poppy seed
• Poultry seasoning
• Rosemary
• Sage
• Savory
• Tarragon
• Thyme
• Turmeric
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This handout is meant for use during an appointment with a registered dietitian only, and is not intended for use by other clinicians.
© 2016 Intermountain Healthcare. All rights reserved. The content presented here is for your information only. It is not a substitute for professional medical advice, and it should not
be used to treat a health problem or disease. Please consult your healthcare provider if you have questions or concerns. Patient and Provider Publications RD033 – 01/17
6